Appointment of Veterans Service Organization as Claimant's Representative (VA Form 21-22), Appointment of Individual as Claimant's Representative (VA Forms 21-22a)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 21-22a Appointment of Individual as Claimant's Representative	Form	Modified	Available
Form 21-22 Appointment of Veterans Service Organization as Claimant's Representative	Form	Modified	Available
Form 21-22 Appointment of Veterans Service Organization as Claimant's Representative (VAF21-22), Appointment of Individual as Claimant's Representative (VAF21-21-22a)	Form	Modified	Repair queued
2023-13022.pdf	Supplementary Document	Uploaded 2023-06-20	Repair queued
Comment-Response (Nos. 1,2,3)(VAF21-22 Series)(6-13-23).docx	Supplementary Document	Uploaded 2023-06-13	Repair queued
2022-26415, 60-Day FRN (2900-0321).pdf	Supplementary Document	Uploaded 2023-01-17	Repair queued
2900-0321, Supporting Statement (VAF21-22 series).docx	Supporting Statement A	Uploaded 2023-06-13	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
28538	Appointment of Veterans Service Organization as Claimant's Representative (VAF21-22), Appointment of Individual as Claimant's Representative (VAF21-21-22a)	Form	Modified	Appointment of Individual as Claimant's Representative
28538	Appointment of Veterans Service Organization as Claimant's Representative (VAF21-22), Appointment of Individual as Claimant's Representative (VAF21-21-22a)	Form	Modified	Appointment of Veterans Service Organization as Claimant's Representative
28538	Appointment of Veterans Service Organization as Claimant's Representative (VAF21-22), Appointment of Individual as Claimant's Representative (VAF21-21-22a)	Form	Modified

ICR Details

OMB Control No: 2900-0321	ICR Reference No: 202111-2900-006
Status: Active	Previous ICR Reference No: 201805-2900-008
Agency/Subagency: VA	Agency Tracking No: VBA-COMP-YA
Title: Appointment of Veterans Service Organization as Claimant's Representative (VA Form 21-22), Appointment of Individual as Claimant's Representative (VA Forms 21-22a)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/31/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/20/2023
Terms of Clearance: OMB is approving this information collection request for a period of three years during which time the agency will request approval to extend or revise the collection if the agency seeks to continue the information collection activity beyond the period approved under this action.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2026	36 Months From Approved
Responses	735,004	0	0
Time Burden (Hours)	61,249	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: VA Forms 21-22 and 21-22a are used to collect the information needed to determine whom claimants have appointed to represent them in the preparation, presentation, and prosecution of claims for VA benefits. The information is also used to determine the extent of representatives’ access to claimants’ records. Without this information VA would be unable to determine whom claimants have appointed to represent them in the prosecution of VA claims, the extent of such representation, and access to appropriate records.

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Authorizing Statute(s): US Code: 38 USC 5701 Name of Law: Confidential nature of claims
   US Code: 38 USC 5903 Name of Law: Recognition with respect to particular claims
   US Code: 38 USC 7332 Name of Law: Confidentiality of certain medical records
   US Code: 38 USC 5702 Name of Law: Furnishing of records
   US Code: 38 USC 5902 Name of Law: Recognition of representatives of organizations
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 74474	12/05/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 13022	06/20/2023
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Appointment of Veterans Service Organization as Claimant's Representative (VAF21-22), Appointment of Individual as Claimant's Representative (VAF21-21-22a)	21-22, 21-22a	Appointment of Veterans Service Organization as Claimant's Representative ,   Appointment of Individual as Claimant's Representative

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	735,004	0	0	415,999	0	319,005
Annual Time Burden (Hours)	61,249	0	0	34,666	0	26,583
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The respondent burden has increased due to the estimated number of receivables averaged over the past year.

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Annual Cost to Federal Government: $4,586,601

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 06/20/2023

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